Browsing by Author "Dikici, Fatih"

Now showing 1 - 13 of 13

A Novel 3D Printed Custom Antibiotic Spacer Mold for Osteomyelitis Cases which are Prone to Instability
(GAZI UNIV, FAC MED, 2018-01-01) Gemalmaz, Halil Can; Sariyilmaz, Kerim; Ozkunt, Okan; Sungur, Mustafa; Kaya, Ibrahim; Dikici, Fatih
Presence of complex bone defects in osteomyelitis treatment may be challenging for the surgeon. Antibiotic cement spacers take a role in managing these defects. The available techniques and systems of antibiotic cement spacers have their pros and cons. There are cases in which these standard options may fail, mainly due to stability related issues. In this report, we present an antibiotic spacer technique in a very complex bone defect that is prone to failure if managed by routine spacer applications. Anticipating that any standard spacer application methodology will fail, we decided to make our own custom antibiotic cement spacer. We used the patient's uninjured side's tomography data to create a custom 3D spacer mold model with the help of a computer software. Later this 3D spacer mold model was printed with a 3D printer. The print out was sterilized and used to cast a custom antibiotic cement spacer resulting in a perfect fit in the defect.
Aarskog-Scott syndrome: An unusual cause of scoliosis
(MEDKNOW PUBLICATIONS \& MEDIA PVT LTD, 2017-01-01) Sariyilmaz, Kerim; Ozkunt, Okan; Korkmaz, Murat; Dikici, Fatih; Domanic, Unsal
A 16-year-old boy who had been diagnosed previously as Aarskog-Scott syndrome (AAS), referred to our clinic with shoulder asymmetry for 1 year. Results of spine examination showed a 52 degrees right thoracic curve at T3-T11. Surgery was planned, and T1-L1 posterior instrumentation and fusion were performed. After surgery, satisfactory correction was achieved, and during 10 years follow-up, the patient had no complaints. AAS is a X-linked genetic disorder with facial, genital, and skeletal manifestations. Scoliosis is not reported as a typical finding of AAS, and there is no reported case in the English literature. Due to mutation affecting the developing skeleton tissue, spinal deformities may develop. In our case, concave side fusion was seen at the deformity. Although we do not know any specific pattern of the scoliotic deformity of this syndrome, surgical correction of the deformity can be difficult because of the premature fusion at these levels.
Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis
(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2017-01-01) Ozkunt, Okan; Karademir, Gokhan; Sariyilmaz, Kerim; Gemalmaz, Halil Can; Dikici, Fatih; Domanic, Unsal
Objective: The aim of this study was to evaluate preoperative and postoperative spinopelvic parameters and the influence of lowest instrumented vertebrae on sagittal parameters in Lenke 5 Adolescent Idiopathic Scoliosis (AIS) patients. Methods: A total of 42 patients (37 females, 5 males
Autologous segmental tibia bone transfer in the treatment of distal tibia Gustilo-Anderson type-III open fracture: A case report
(ELSEVIER SCI LTD, 2016-01-01) Demirel, Mehmet; Akgul, Turgut; Polat, Gokhan; Cakmak, Mehmet Fevzi; Dikici, Fatih
INTRODUCTION: We present the results of a two-stage reconstruction performed with autologous segmental tibia bone transfer on a distal tibia Gustilo-Anderson type-IIIC open fracture in this paper. Our aim is to discuss the results of this surgery, potential failures and complications in our procedures, and ways to protect against osteolysis. PRESENTATION OF CASE: A 20-year-old male who has undergone surgery in our clinic for a Gustilo-Anderson type-III open fracture of the left tibia using autologous tibia segmental bone transfer. The first operation consisted of removing the exposed bony fragment and placing it in the abdominal wall. Fifty days after the first operation, an intramedullary nailing operation was performed using the autologous bone fragment kept in the abdominal wall. Before the final procedure, we assessed the viability of the bone fragment using scintigraphy as well as the paprika sign was observed on the fragment during operation. Patient was seen in follow-up every three weeks to evaluate for successful osteosynthesis
Does pedicle screw density matter in Lenke type 5 adolescent idiopathic scoliosis?
(LIPPINCOTT WILLIAMS \& WILKINS, 2018-01-01) Sariyilmaz, Kerim; Ozkunt, Okan; Karademir, Gokhan; Gemalmaz, Halil Can; Dikici, Fatih; Domanic, Unsal
The aim of this study is to compare the effects of high versus low implant density on correction in Lenke type 5 adolescent idiopathic scoliosis (AIS) patients. A retrospective study of 59 Lenke type 5 AIS patients treated at a single institution were divided into to 2 groups according to implant density. Implant density, preoperative, early postoperative, and last follow-up thoracolumbar/lumbar (TL/L) curves were measured. Thirty-one constructs were high and 28 constructs were low density. The groups were similar in terms of age, sex, Cobb angle, and follow-up time. Mean implant density in low density group and high density group was 75.4\% and 96.6\%, respectively. High versus low-density comparison showed that there is no significant difference with regard to curve correction in early postoperative and last follow-up periods. The results show that pedicle screw density being low or high, does not affect curve correction rates in the short and long term in our patients.
Does the Screw Orientation Effects the Stability of Femoral Neck Fracture?: A Finite Element Analysis
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2018-09-01) Özkunt, Okan; Sarıyılmaz, Kerim; Akgül, Turgut; Polat, Gökhan; Dikici, Fatih
ABSTRACT Objectives: The incidence of femoral neck fractures in younger-age people increases due to high-energy trauma. To avoid complications, stable internal fixation is essential. The most commonly used implants for vertically oriented femoral neck fractures are the cannulated and dynamic hip screws. In our study, we compared differently oriented cannulated screw configurations and a standard DHS for fixation of femoral neck fracture. Materials and Methods: A finite element-based collum femoris fracture was created and was fixed using four differently oriented triangular screw configurations and a dynamic hip screw. The loads were applied using a commercially available software package. Results: Centrally oriented cannulated screw configuration had the most compression and compression stress on the fracture side, and it had the highest stress values on the implant. Conclusion: We recommend the use of centrally oriented triangular cannulated screws for femoral neck fracture fixation. With this construct, more compression and compression pressure can be obtained, which can result in the early healing of the fracture. However, it must be kept in mind that this construct exerts more stress on the implant, which could be a reason for implant failure.
Influence of Distal Fusion Level on Sagittal Spinopelvic and Spinal Parameters in the Surgical Management of Adolescent Idiopathic Scoliosis
(KOREAN SOC SPINE SURGERY, 2018-01-01) Akgul, Turgut; Sariyilmaz, Kerim; Korkmaz, Murat; Ozkunt, Okan; Kaya, Ozcan; Dikici, Fatih
Study Design: trospective analysis of adolescent idiopathic scoliosis. Purposep: s study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery. Overview of Literature: e distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS. Methods: total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed. Results: e mean age was 15+/-2.4 years, and the mean follow-up period was 24.27+/-11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60+/-13.30 degrees preoperatively to 26.00+/-7.3 degrees postoperatively in each group (p=0.001). LL decreased from 52.8+/-9.4 degrees preoperatively to 44.30+/-7.50 degrees postoperatively (p=0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups (p<0.05). In addition, in group 2, PI decreased from 50.60+/-8.74 degrees preoperatively to 48.00+/-6.84 degrees postoperatively (p=0.027). SS decreased from 35.20+/-6.40 degrees preoperatively to 33.40+/-5.80 degrees postoperatively (p=0.08, p>0.05). However, mean SS was significantly higher in group 3 (p=0.042, p<0.05). PT decreased from 15.50+/-7.90 degrees preoperatively to 15.2+/-7.10 degrees postoperatively. The positive relationship (28.5\%) between LL and PI measurements was statistically significant (r=0.285
Investigation of efficacy of treatment in spinal cord injury: Erythropoietin versus methylprednisolone
(SAGE PUBLICATIONS INC, 2017-01-01) Ozkunt, Okan; Sariyilmaz, Kerim; Gemalmaz, Halil Can; Gurgen, Seren Gulsen; Yener, Ulas; Dikici, Fatih
Background: Investigation of the expression of platelet-derived growth factor (PDGF)-beta and glial fibrillary acidic protein (GFAP) in rats with spinal cord injury as a marker of neurologic recovery between groups treated with erythropoietin (EPO) and methylprednisolone (MP). Methods: Thirty adult female rats were randomly divided into three even groups. A laminectomy was applied to thoracic ninth vertebra and contusion injury was induced by extradural application of an aneurysm clip. Group 1 rats received one-time intrathecal administration of normal saline, group 2 rats received MP, and group 3 rats received EPO. Motor neurological function was evaluated by the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Thirty days after the surgery, T8-10 segments of the spinal cords were extracted and the immunohistochemical assay revealed the number of PDGF-beta- and GFAP-positive cells. Results: Evaluation of the last control animal showed that BBB score in the EPO group showed an increase from 1 to 12 (p < 0.05). The immunohistochemical assay revealed that the number of PDGF-beta- and GFAP-positive cells was significantly higher in EPO group (p = 0.000) when compared to MP and control groups. After studying the effect of PDGF-beta expression on the locomotor function, we determined that PDGF-beta expression and locomotor function after a spinal injury has a strong relationship (p < 0.05). Conclusion: EPO seems to better increase the expression of PDGF-beta, thus produce better results in locomotor functions when compared to MP.
Posterior Approach Alone Versus Combined Anterior and Posterior Approach in the Management of Vertebral Tuberculosis
(TURKISH NEUROSURGICAL SOC, 2019-01-01) Demirel, Mehmet; Akgul, Turgut; Pehlivanoglu, Tuna; Karademir, Gokhan; Bayram, Serkan; Dikici, Fatih; Sar, Cuneyt
AIM: To compare posterior surgery alone versus combined anterior and posterior surgery for the management of spinal tuberculosis. MATERIAL and METHODS: Data from 31 consecutive patients who underwent surgery for spinal tuberculosis were analyzed retrospectively. Patients were divided into two groups as group A (posterior surgery alone) or group B (combined anterior and posterior surgery), and groups were compared in terms of invasiveness of the procedure, spinal deformity, fusion, neurological status, and postoperative complications. RESULTS: Group A included 16 patients (mean age: 56 years, range: 29-75) with a mean follow-up period of 29 months (range 12-60) while group B included 15 patients (mean age: 60 years, range: 35-73) with a mean follow-up period of 28 months (range 12-60). Procedurally, average operation time and mean length of hospitalization were shorter, and mean blood loss was lower in group A (p<0.05) compared to group B. Postoperative bone fusion took significantly (p<0.05) longer time in group A (10.5 +/- 2.1 months)than in group B (9.3 +/- 3.1 months), and all patients with a neurological deficit recovered completely during the postoperative period. No significant differences were observed between two groups with respect to postoperative complications (p>0.05). CONCLUSION: Combined anterior-posterior surgery may not be required for treating vertebral tuberculosis as posterior surgery alone appears to be sufficient.
Postoperative mechanical alignment analysis of total knee replacement patients operated with 3D printed patient specific instruments: A Prospective Cohort Study
(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2019-01-01) Gemalmaz, Halil Can; Sariyilmaz, Kerim; Ozkunt, Okan; Sungur, Mustafa; Kaya, Ibrahim; Dikici, Fatih
Objective: Total knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community. Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments. Methods: Two groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients' computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients' preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3 degrees of malalignment were counted in both groups for comparison. Results: The average postoperative mFTA was found to be 2.09 degrees for the PSI group and in was found to be 2.84 degrees for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3 degrees of malalignment per group were found to be 1 out of 20 (5\%) for the PSI group and 7 out of 20 (35\%) for the control which was statistically significant. Conclusion: In this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3 degrees. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment. (C) 2019 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.
Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods
(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2018-01-01) Dikici, Fatih; Akgul, Turgut; Sariyilmaz, Kerim; Korkmaz, Murat; Ozkunt, Okan; Sar, Cuneyt; Domanic, Unsal
Objective: The aim of this study was to investigate the effect of distal fusion level selection on the distal junctional kyphosis (DJK) in Scheuermann kyphosis (SK) patients who underwent posterior fusion. Methods: Thirty-nine SK patients who underwent posterior fusion with a minimum follow-up of 3 years were retrospectively evaluated. According to the distal fusion level, patients were divided into 3 groups. Group S
Surgical Approach Algorithm in the Treatment of Lumbar and Thoracolumbar Pyogenic Spondylodiscitis
(TURKISH NEUROSURGICAL SOC, 2022-01-01) Akgul, Turgut; Bayram, Serkan; Korkmaz, Murat; Karalar, Sahin; Dikici, Fatih; Sar, Cuneyt
AIM: To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure. MATERIAL and METHODS: Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of >1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria. RESULTS: The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injury
The effect of tourniquet usage on cement penetration in total knee arthroplasty A prospective randomized study of 3 methods
(LIPPINCOTT WILLIAMS \& WILKINS, 2018-01-01) Ozkunt, Okan; Sariyilmaz, Kerim; Gemalmaz, Halil Can; Dikici, Fatih
Background: It is a randomized study to compare cement penetration on x-rays after total knee arthroplasty (TKA) among 3 different ways to use tourniquets